Provider Demographics
NPI:1699480731
Name:CHUMLEY, CAITLIN BRIA (PTA)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:BRIA
Last Name:CHUMLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:BRIA
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 RACETRACK RD
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547
Mailing Address - Country:US
Mailing Address - Phone:850-889-4550
Mailing Address - Fax:
Practice Address - Street 1:310 RACETRACK RD NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1553
Practice Address - Country:US
Practice Address - Phone:850-889-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26674225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant